Are we on the right track in DBS surgery for dystonic head tremor? Polymyography is a promising answer


      • Polymyography during DBS surgery for head tremor can facilitate optimal electrode placement.


      The clinical benefit of Deep Brain Stimulation (DBS) is associated with electrode positioning accuracy. Intraoperative assessment of clinical effect is therefore key. Evaluating this clinical effect in patients with dystonic head tremor, as opposed to limb tremor, is challenging because the head is fixed in a stereotactic frame. To clinically assess head tremor during surgery, surface electromyography (EMG) electrodes were bilaterally applied to the sternocleidomastoid and cervical paraspinal muscles. This case shows that intraoperative polymyography is an easy and useful tool to assess the clinical effect of DBS electrode positioning.


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        • Anheim M.
        • Batir A.
        • Fraix V.
        • Silem M.
        • Chabardès S.
        • Seigneuret E.
        • et al.
        Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.
        Arch. Neurol. 2008; 65: 612-616
        • Ellis T.M.
        • Foote K.D.
        • Fernandez H.H.
        • Sudhyadhom A.
        • Rodriguez R.L.
        • Zeilman P.
        • et al.
        Reoperation for suboptimal outcomes after deep brain stimulation surgery.
        Neurosurgery. 2008; 63: 754-760
        • Lange S.F.
        • Kremer N.I.
        • van Laar T.
        • et al.
        The intraoperative microlesion effect positively correlates with the short-term clinical effect of deep brain stimulation in Parkinson's disease.
        Neuromodulation. 2021; ([published online ahead of print, 2021 Sep 7]) (10.1111/ner.13523)
        • Mahajan A.
        • Bader A.
        • Wang L.L.
        • et al.
        Thalamic Deep Brain Stimulation for tremor: the critical role of intraoperative testing.
        Park. Relat. Disord. 2020; 73: 45-49
        • Coenen V.A.
        • Allert N.
        • Mädler B.
        A role of diffusion tensor imaging fiber tracking in deep brain stimulation surgery: DBS of the dentato-rubro-thalamic tract (drt) for the treatment of therapy-refractory tremor.
        Acta Neurochir (Wien). 2011; 153: 1579-1585
        • Tsuboi T.
        • Jabarkheel Z.
        • Zeilman P.R.
        • et al.
        Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor.
        Neurology. 2020; 94: e1073-e1084
        • Poologaindran A.
        • Ivanishvili Z.
        • Morrison M.D.
        • et al.
        The effect of unilateral thalamic deep brain stimulation on the vocal dysfunction in a patient with spasmodic dysphonia: interrogating cerebellar and pallidal neural circuits.
        J. Neurosurg. 2018; 128: 575-582